标准截面形状定制型股骨柄假体设计

目的 介绍一种标准截面形状定制型股骨柄假体结构以及自行开发的设计方法。方法首先利用DICOM格式的患者股骨CT图像,重建患者股骨近端模型;根据重建出的患者股骨近端模型构建股骨柄假体匹配段矩形的截面边界,并在矩形截面边界内用简单的线条初步构建出假体的截面轮廓曲线;利用股骨近端模型对初步设计出的股骨柄假体进行验证,并通过调整设计参数使最终设计出的个性化股骨柄假体与患者股骨髓腔相匹配。结果 定制型人工髋关节股骨柄假体采用标准截面形状,便于快速设计出个性化假体,而且设计操作简单。参数化程序设计大大降低了个性化股骨柄假体的设计工作量。结论 标准截面形状定制型股骨柄假体的设计将有助于提高定制型人工髋关节置换手术的成功率,促进定制型股骨柄假体在临床上的应用,进一步提高患者的生活质量。     

Flexible Removable Partial Denture Prosthesis: A Survey of Dentists’ Attitudes and Knowledge in Greece and Croatia

Purpose

The aim of this study was to investigate through a questionnaire the knowledge, attitudes and possible differences in the use of flexible RPDPs among dentists in Greece and Croatia.

Material and Methods

A questionnaire of 16 questions was originally created in English, translated into Greek and Croatian language following a two way translation and tested for apprehension, precision, clarity and homogeneity by a number of native English speaking Greek and Croatian dentists. Following the necessary corrections, the questionnaires replicated in two online surveys and their addresses with an informed consent were sent by emails to nearly 4000 dentists in each country to participate. Collected data were analyzed by chi-square tests at a= .05 level of significance.

Results

378 dentists from Greece and 304 from Croatia participated in the study. 137(36.2%) dentists from Greece and 56(18.4%) from Croatia provided flexible RPDPs to their patients. Statistical analysis for all providers indicated no significant difference between genders (P>.05), significant differences between age groups (P<.01), years of practice (P<.05), specialization (P <.001), and instruction on flexible prostheses (P <.001). The analysis between the two countries showed differences for gender and age groups (P<.01) but no differences between experienced, specialized or instructed groups (P >.05).

Conclusion

The survey indicated differences between the two countries in the percentages of dentists using, selecting and providing RPDPs for their patients. Practitioners’ age, years in practice and instruction were associated with the provision of the prostheses, while comfort, esthetics and cost were the reasons for deciding to use the flexible RPDPs.

Conclusion

Although dentists are not educated in their schools about flexible RPDPs, almost a third of them offer this treatment to their patients. Long term success of these devices depends on clinical education, more experience and definitely more research.     

Retrieval Technique for Full‐Arch Implant‐Supported Fixed Prosthesis: A Clinical Report

In the event of the loss of an implant and to take advantage of the preexisting structures, a rescue procedure that allows continuous use of the original fixed restoration during the restoration of the tripod support at the implant level can be used. When nonphysiological occlusion forces are avoided, the success rate of this rescue procedure is very similar to any other rehabilitation made following a conventional protocol. Furthermore, the fact that the patient has already adapted to the prosthesis position and its vertical dimension results in easier functional adaptation in the postoperative period and, consequently, greater comfort.     

Morphological spectrum of renal pathology and its correlation to clinical features in patients with disseminated intravascular coagulation: A study involving a series of 21 autopsy cases

Disseminated intravascular coagulation (DIC), a thrombohemorrhagic disorder, occurs as a secondary complication in many diseases, but the histopathological features of kidneys in DIC have not been extensively characterized thus far. We reviewed 21 autopsy cases of patients with a clinical diagnosis of DIC and studied the repertoire of renal pathology. Eighteen patients had elevated serum creatinine levels and 15 patients had a variable degree of proteinuria. Underlying disorders included malignant neoplasms in 12 patients, and abdominal aortic aneurysm, acute myocardial infarction, and systemic infections in other patients. Coexistent glomerular pathology, such as focal segmental glomerulosclerosis (FSGS) with different morphological variants, and microthrombi formation, was present in many patients. The microthrombi were histologically similar to that seen in thrombotic microangiopathy, but characteristics associated with DIC were detected by special staining. The presence of FSGS correlated with the degree of urinary protein (P = 0.0044), and the presence of acute tubular injury (ATI) and the extent of global glomerulosclerosis both correlated with serum creatinine levels (P = 0.019 and 0.0003, respectively). FSGS was probably due to endothelial cell damage, another potential etiology for FSGS. Global glomerulosclerosis, a result of previous renal injury, can be a determinant of renal function during the acute phase of DIC.     

End-Stage Renal Disease and Mortality Outcomes Across Different Glomerulonephropathies in a Large Diverse US Population

Objective

To compare renal function decline, incident end-stage renal disease (ESRD), and mortality among patients with 5 common glomerular diseases in a large diverse population.

Collapsing focal segmental glomerulosclerosis in a patient with oral cavity cancer: A case report

Rationale:Focal segmental glomerulosclerosis (FSGS) is one of the most common glomerular diseases, leading to end-stage renal disease. Among the 5 variants of FSGS, the collapsing variant is rare and has the worst prognosis. Solid and hematologic malignancies are associated with glomerular diseases, such as membranous nephropathy, minimal change disease, and FSGS. However, squamous cell carcinoma of the oral cavity is rarely associated with nephrotic syndrome, especially FSGS.Patient concerns:A 55-year-old woman diagnosed with oral cavity cancer presented with generalized edema with heavy proteinuria and renal dysfunction after neoadjuvant chemotherapy and wide surgical excision.Diagnosis:Renal biopsy shows segmental or global collapse of glomerular capillaries with marked hyperplasia and swelling of overlying epithelial cells, suggesting a collapsing variant of FSGS.Interventions:After the renal biopsy, we prescribed oral prednisolone at a dose of 1 mg/kg/day. Despite immunosuppressive treatment, renal function deteriorated, and hemodialysis was started.Outcomes:After 23 sessions of hemodialysis and high-dose oral glucocorticoid treatment, renal function gradually improved, and oral glucocorticoid therapy was discontinued after 8 months. Currently, this patient is in a cancer-free state and has normal renal function without proteinuria.Lessons:Unusual collapsing FSGS might be associated with neoadjuvant chemotherapy and wide surgical excision in patients with oral cavity cancer. Proper diagnostic workup, such as renal biopsy and high-dose glucocorticoid therapy, might have helped recover from nephrotic syndrome and acute renal injury in cancer patients.     

Does washing medical devices before and after use decrease bacterial contamination?: An in vitro study

Surface treatment of medical devices may be a way of avoiding the need for replacement of these devices and the comorbidities associated with infection. The aim of this study was to evaluate whether pre- and postcontamination washing of 2 prostheses with different textures can decrease bacterial contamination.The following microorganisms were evaluated: Staphylococcus aureus, Staphylococcus epidermidis, Proteus mirabilis and Enterococcus faecalis. Silicone and expanded polytetrafluoroethylene vascular prostheses were used and divided into 3 groups: prostheses contaminated; prostheses contaminated and treated before contamination; and prostheses contaminated and treated after contamination. Treatments were performed with antibiotic solution, chlorhexidine and lidocaine. After one week of incubation, the prostheses were sown in culture medium, which was incubated for 48 hours. The area of colony formation was evaluated by fractal dimension, an image analysis tool.The antibiotic solution inhibited the growth of S epidermidis and chlorhexidine decrease in 53% the colonization density for S aureus in for both prostheses in the pre-washing. In postcontamination washing, the antibiotic solution inhibited the growth of all bacteria evaluated; there was a 60% decrease in the colonization density of S aureus and absence of colonization for E faecalis with chlorhexidine; and lidocaine inhibited the growth of S aureus in both prostheses.Antibiotic solution showed the highest efficiency in inhibiting bacterial growth, especially for S epidermidis, in both washings. Lidocaine was able to reduce colonization by S aureus in post-contamination washing, showing that it can be used as an alternative adjuvant treatment in these cases.     

国内外定制式增材制造医疗器械监管法规概述及对行业发展的思考

目的 概述国内外定制式增材制造医疗器械监管法规,分析医疗器械监管科学研究对增材制造医疗器械行业发展的意义,以期能够为生产企业及监管机构未来的工作提供参考。方法 该文通过对国内外关于定制式增材制造医疗器械监管法规及注册体系进行分析,剖析定制式增材制造医疗器械监管法规及注册体系的创新发展对于我国医疗器械行业发展的拉动效应。结果 美国、欧盟、澳大利亚、加拿大、中国均已建立定制式增材制造医疗器械监管法规及注册体系,给出了定制式医疗器械的定义,明确了定制式医疗器械临床使用和上市后监管的要求,但各国间还存在一定的差异,使得各国对于定制式医疗器械的监管模式也稍有差异,建立医疗器械科学监管模式将推动增材制造医疗器械行业发展。结论 构建基于精准风险控制的评价监管体系,加强监管人员、审评人员与科研、医疗人员间的相互协同作用将有助于定制式增材制造医疗器械科学监管模式的构建。     

Focal segmental glomerulosclerosis and mild intellectual disability in a patient with a novel de novo truncating TRIM8 mutation

Mutations in the TRIM8 gene have been described in patients with severe developmental delay, intellectual disability and epilepsy. Only six patients have been described to date. All the previous mutations were truncating variants clustered in the C-terminus of the protein. A previous patient with TRIM8-related epileptic encephalopathy was reported to have nephrotic syndrome. Here we describe the clinical, radiological and histological features of an 8-year-old male patient with a TRIM8 mutation who, in contrast to previous patients, had only mild intellectual disability and well-controlled epilepsy. The patient was found to have proteinuria at 2 years of age. Renal biopsy findings were suggestive of focal segmental glomerulosclerosis. His kidney function declined and peritoneal dialysis was started at 5 years of age. He underwent renal transplant at 7 years of age. Trio-based whole genome sequencing identified a novel de novo heterozygous frameshift mutation in TRIM8 (NM_030912.2) c.1198_1220del, p.(Tyr400ArgfsTer2). This patient is further evidence that TRIM8 mutations cause a syndrome with both neurological and renal features. Our findings suggest the spectrum of TRIM8-related disease may be wider than previously thought with the possibility of milder neurodevelopmental problems and/or a more severe, progressive renal phenotype. We highlight the need for proteinuria screening in patients with TRIM8 mutations.